Maranya Samora Onsare, Mutiso Vincent Muoki
Department of Orthopaedic Surgery, University of Nairobi, PO Box 19676-00202, Kenyatta National Hospital, Nairobi, Kenya.
Department of Orthopaedic Surgery, University of Nairobi, PO Box 19676-00202, Kenyatta National Hospital, Nairobi, Kenya; Division of Orthopaedics, Kenyatta National Hospital, Nairobi, Kenya.
Int J Surg Case Rep. 2021 Nov;88:106502. doi: 10.1016/j.ijscr.2021.106502. Epub 2021 Oct 15.
Septic arthritis is an orthopaedic emergency. Only 3% of septic arthritis patients present with glenohumeral involvement. Polyarticular disease with shoulder involvement constitutes 1% of this group. There is currently no documented case of bilateral glenohumeral septic arthritis with avascular necrosis secondary to mastitis.
We present a case of a 38-year-old African woman with bilateral glenohumeral septic arthritis after management for mastitis of the left breast. She had left, then right shoulder pain, fever, and reduced range of motion, with multiple arthroscopic washouts and antibiotic therapy instituted at various hospitals by various specialists, leading to the resolution of active infection. The patient developed bilateral humeral head avascular necrosis with complete collapse as evidenced on plain radiography 4 months later, and underwent hemiarthroplasty of the right shoulder. Biopsy at operation showed no active bone infection, and inflammatory markers were not elevated. She had reduced discomfort for the following 2 years but developed increasing pain on lifting and reduced range of motion. The moderate symptoms in her left shoulder managed non-operatively had remained unchanged. There were no elevated inflammatory markers 2-years post arthroplasty.
This case presents an uncommon scenario of bilateral septic arthritis secondary to mastitis, with rapid progression to avascular necrosis in an individual with no classical risk factors for avascular necrosis, despite appropriate antibiotic treatment and surgical interventions. Advanced collapse necessitated hemiarthroplasty of the dominant right side.
This case highlights the need for close radiographic follow-up in atypical presentations of septic arthritis and the dilemmas in managing advanced bilateral avascular necrosis with arthroplasty in a young patient.
化脓性关节炎是一种骨科急症。仅有3%的化脓性关节炎患者存在盂肱关节受累情况。伴有肩部受累的多关节疾病在该组患者中占1%。目前尚无关于乳腺炎继发双侧盂肱关节化脓性关节炎并伴有缺血性坏死的文献记载病例。
我们报告一例38岁非洲女性，在左侧乳腺炎治疗后发生双侧盂肱关节化脓性关节炎。她先是左侧肩部疼痛，随后右侧肩部疼痛，伴有发热和活动范围减小，多位专科医生在多家医院对其进行了多次关节镜冲洗和抗生素治疗，使活动性感染得到缓解。4个月后，X线平片显示患者双侧肱骨头出现缺血性坏死并完全塌陷，遂对其右侧肩部进行了半关节置换术。手术活检显示无活动性骨感染，炎症指标未升高。在接下来的2年里，她的不适症状有所减轻，但在提举时疼痛加剧，活动范围减小。其左侧肩部症状较轻，采用非手术治疗，症状未变。关节置换术后2年，炎症指标未升高。
该病例呈现了一种不常见的情况，即乳腺炎继发双侧化脓性关节炎，尽管进行了适当的抗生素治疗和手术干预，但在一个没有缺血性坏死典型危险因素的个体中，病情迅速发展为缺血性坏死。晚期塌陷使得对功能占优的右侧肩部进行半关节置换术成为必要。
该病例强调了在化脓性关节炎非典型表现中进行密切影像学随访的必要性，以及在年轻患者中采用关节置换术治疗晚期双侧缺血性坏死时所面临的困境。
